MEDICARE: DR. ROBERT BEN CULP III D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2396	SC

General Provider Information

NPI Number	:	1043349723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT BEN CULP III D.M.D.

Provider Business Mailing Address
First Line	:	1627 JOHN B WHITE SR BLVD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29301-4409
Country	:	US
Telephone Number	:	864-574-5065
Fax Number	:

Provider Business Practice Location Address
First Line	:	1627 JOHN B WHITE SR BLVD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29301-4409
Country	:	US
Telephone Number	:	864-574-5065
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	07/08/2007

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